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The Overdue Blues

Finally, your due date arrives, and you're all set to greet your baby. Then...nothing. You're still pregnant the next day, and the next, and the next. Tired and on edge, you wonder if it's possible to deliver a 2-year-old.

I can relate. Pregnant with my third baby, I was convinced that I was going to deliver early. Wrong. Not only did I make it to my due date, but I was still pregnant two weeks later. I took advice from anyone and everyone on how to stimulate labor. My husband and I had sex, over and over again. It didn't work. I indulged in Chinese meals and other supposedly labor-inducing fare. Five pounds later, the baby still wouldn't budge. We drove over bumpy roads, but my water remained stubbornly intact.

Two weeks after my due date, my doctor induced labor. Six hours later a 10-pound girl, Samantha, was born. At last, my seemingly endless pregnancy was over.

LATE FOR THE PARTY

Babies are regarded as full-term between 37 and 42 weeks of gestation. But one in ten infants arrives after 42 weeks. "Remember, you're considered post-term at 42 weeks -- not at 40," notes Iffath Hoskins, M.D., chief of obstetrics at the New York University Downtown Hospital. In fact, since a due date is at best an educated guess, many "overdue" babies aren't really late at all. Even if the due date is right, doctors aren't sure why some babies need to gestate for longer than others, but they do know that first-time mothers tend to deliver later than veteran moms.

While more than 90 percent of post-term babies are delivered safely, the risk of complications tends to increase as pregnancy stretches on, according to Kathryn Moyer, M.D., an ob-gyn in Santa Monica, CA. One reason: The placenta, which transports oxygen and nutrients to the fetus, may function less efficiently after 40 weeks. In addition, babies left to grow inside the womb can become too large to pass safely through the birth canal, so a c-section becomes more likely.

TESTING, 3

In order to keep an eye on the situation, your doctor will monitor you closely after the 40-week mark. You may have a weekly vaginal exam to determine whether your cervix is softening and dilating, and you'll be asked to perform daily "kick tests," during which you count the baby's movements for a set period of time. For some women, 41 weeks marks the beginning of nonstress tests, in which a fetal monitor measures the baby's heart rate to see how he's faring during his extended stay in the womb.

"The monitoring is important because there's a risk of fetal distress as the amniotic fluid diminishes," a common occurrence in post-term pregnancies, Moyer explains. Cushioned by less fluid, the baby may wind up resting on the umbilical cord, which reduces his supply of nourishment and oxygen. This in turn leads to distress, causing him to pass stool into the amniotic fluid, which can result in airway blockage.

In addition to nonstress tests, many women also have regular ultrasounds to determine amniotic-fluid levels as well as the baby's size, and they may be asked to undergo stress tests. Mild contractions are induced by nipple stimulation or an injection of Pitocin, and the baby's heart rate is monitored to see how well he's likely to cope with the rigors of true labor.

GIVING NATURE A NUDGE

There are several methods thought -- or at least rumored -- to kick-start a tardy labor. Your caregiver may recommend exercise (walking is known to encourage labor), nipple stimulation (which can spur contractions), and sex (semen contains prostaglandins, hormones that help prepare the cervix for delivery).

In addition, some practitioners advise taking castor oil or using an enema to irritate the bowel, since this may lead to uterine contractions. Certain herbs are also thought to promote labor by ripening the cervix or by bringing on contractions. They include raspberry leaves (ingested in the form of a tea), extracts from the black or blue cohosh plants (taken orally or in an enema), and evening primrose oil (consumed in capsule form or applied to the cervix). Of course, be sure to check with your obstetrician before giving any of these folk remedies a spin.

PULLING OUT ALL THE STOPS

If all else fails and your baby simply refuses to budge, your doctor will likely start talking about inducing labor. But as long as mom and baby are both healthy, overdue mothers-to-be who want to go the natural route shouldn't feel pressured to submit to an induction before 42 weeks, says Richard Schwarz, chairman of the department of obstetrics and gynecology at New York Methodist Hospital. If labor doesn't look imminent at 42 weeks or if the baby shows signs of distress before then, your obstetrician will call in the big guns -- membrane stripping, prostaglandin gel, membrane rupture, and Pitocin.

First, for membrane stripping, the doctor inserts a gloved finger through the cervix and sweeps it over the membranes that connect the amniotic sac to the uterine wall, which causes cramping and the release of natural prostaglandins that may help ripen the cervix and stimulate contractions. Next, she may administer a prostaglandin gel vaginally or use a crochetlike hook to rupture the bag of waters. If contractions don't start within 24 hours of the amniotic sac being broken, the chance of uterine infection increases and Pitocin will be administered. Given intravenously, this synthetic version of the hormone oxytocin is a nearly foolproof method for bringing on labor. But be warned -- some women report that the contractions induced by Pitocin are longer, stronger, and more painful than natural contractions. There may also be a greater chance of uterine rupture and fetal distress when Pitocin is used.

In the end, whatever methods are employed in an effort to bring your slightly tardy infant into the world, there's one important point to remember: Your baby will get here -- and when he does, 40-plus weeks of pregnancy may seem like a breeze in comparison.